Hypereosinophilic syndrome with cardiac infiltration and congestive heart failure in a cat.

Hypereosinophilic syndrome is an uncommon disorder in the cat. It is a heterogeneous group of conditions defined by a persistent hypereosinophilia associated with organ damage directly attributable to tissue hypereosinophilia. A seven-year-old castrated domestic shorthair cat presented to the emergency service for dyspnea. Initial physical examination identified the presence of a grade III/VI systolic left parasternal murmur with no gallop or arrhythmia. A snap N-terminal-pro hormone brain natriuretic peptide was abnormal, and a point-of-care ultrasound revealed mild pleural effusion, scant pericardial effusion, and an enlarged left atrium. There was leukemia (72.35 K/uL, reference range 4.5-15.7 K/uL) predominated by eosinophilia (33.84 K/uL; reference range 0-1.9 K/uL). On echocardiogram, there was concentric hypertrophy of the left ventricular walls with irregular endocardial borders. The left atrium was enlarged with evidence of spontaneous echogenic contrast. The mitral valve was thickened with a vegetative lesion on the anterior leaflet. Despite treatment, the patient experienced cardiopulmonary arrest, and cardiopulmonary resuscitation was unsuccessful. Complete necropsy with histopathology revealed eosinophilic infiltrates in multiple organs and the presence of a severe, acute-on-chronic, fibrinous, and eosinophilic-granulomatous endomyocarditis with mural thrombosis and marked endocardial fibrosis. This case represents an unusual presentation of the hypereosinophilic syndrome in the cat with cardiac involvement and congestive heart failure as a primary clinical sign.

Primary cardiac hemangiosarcoma in a horse: echocardiographic and necropsy findings.

Cardiac hemangiosarcoma, especially primary, is infrequently reported in the horse and remains a diagnostic challenge because of vague clinical signs and difficulty to reach an antemortem diagnosis. A 17-year-old American Quarter Horse gelding was presented with a history of tongue swelling and secondary aspiration pneumonia. Initial assessment indicated dehydration, and thoracic ultrasound revealed an abnormal structure within the myocardium alongside the previously suspected aspiration pneumonia. A subsequent, complete echocardiogram identified a large, heterogeneous, ill-defined mass invading and replacing the normal myocardium of the right ventricular free wall. Because of lack of improvement the horse was euthanized, and postmortem examination confirmed primary cardiac hemangiosarcoma with no further masses identified in other organs. This case is an unusual presentation of primary cardiac hemangiosarcoma for which echocardiography played a significant role in identifying a cardiac mass.

Nature of the clinical difficulties of first-year family medicine residents under direct observation.

OBJECTIVE: To determine and classify the difficulties of first-year family medicine residents observed during clinical interviews. DESIGN: Retrospective, descriptive study. SETTING: Family practice unit at a teaching hospital. PARTICIPANTS: Forty-seven of the 56 first-year family medicine residents during their 2-month compulsory rotation in ambulatory family medicine, between July 1983 and December 1988, and 4 physicians who supervised the residents. MAIN OUTCOME MEASURE: The residents' difficulties noted on the observation forms. MAIN RESULTS: A total of 1500 difficulties were observed during 194 interviews, an average of 7.7 (standard deviation 5.2) per interview. There were 167 different difficulties, which were classified into seven categories (introduction, initial contract, body of the interview, techniques and organization, interpersonal aspects, final contract and miscellaneous) and 20 subcategories. The 17 most frequently noted difficulties accounted for 40% of the total. CONCLUSIONS: The results constitute a useful starting point for developing a classification of residents' difficulties during clinical interviews. We believe that the list of difficulties is applicable to residents at all levels and in other specialties, especially in ambulatory settings. The list can be used to develop learning materials for supervisors and residents.